When should I consider referring a patient with suspected melanoma to

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Refer a patient with suspected melanoma urgently using a suspected cancer pathway (for an appointment within 2 weeks) if:

They have a suspicious pigmented lesion with a weighted 7-point checklist score of 3 or more .
Dermoscopy suggests melanoma .
There are nail changes, such as a new pigmented line in the nail (especially if there is associated damage to the nail), or a lesion growing under the nail .
They have a new persistent skin condition, especially if growing, pigmented, or vascular in appearance and the diagnosis is unclear .
There is any doubt about the lesion, or there is a history of recent change .
A biopsy has confirmed the diagnosis of malignant melanoma .

Consider referring using a suspected cancer pathway (within 2 weeks) if they have:

A pigmented or non-pigmented skin lesion that suggests nodular melanoma .
Any major feature in the 7-point checklist, or any features of the ABCDE system .

Most regions will have a local referral form for pigmented lesions; if not, include detailed history, examination, and risk factors .

When should I consider referring a patient with suspected melanoma to a dermatologist for further evaluation?